EHC organization has managed to maintain profits in order to remain in operation, because of their good reputation. Beside the organization’s great patient care, certain departments have invested in making poor financial decisions, which are now becoming a hindrance to the organizations profits. In the recent reviews of the organization financial data, the center has given huge discounts to managed care organizations, such as Medicaid/Medicare. When an organization deals with negotiating a set or contracted price for services, the reimbursements for these services are more than likely to be below the organization’s budget standards. The contracted fees set for the reimbursement of the insurance rate where not based on the past medical cost, this could stop the organization from receiving profitable financial growth. The organization’s nursing staff has been compromised, due to the organization paying outside contracted wages, to the agencies that supplied the organization with these particular staff members. More than half of the organization’s liablities have increased, the accounts payables are the main reason for this increase. The EHC will need to replace their old outdated equipment with the latest equipment…
Understanding health care financial terms is a prerequisite for both academic and professional success. This assignment is intended to ensure you understand some of the basic terms used in this course.…
The purpose of a managed care organization is to coordinate the costs and delivery of health care. A managed care organization oversees money spent on labor, technology, and facilities such as physician offices and hospitals. A type of managed care organization is a Health Maintenance Organization (HMO). A HMO “provides medical care for all its enrollees in return for a fixed annual fee per enrollee” (University of Phoenix, 2010, Key Terms and Concepts Section). An HMO tightly oversees the use of health care services thereby reducing costs and controlling utilization. For example, HMO’s…
As you learn about health care delivery in the United States, it is important to understand the various models of health insurance to develop a working knowledge as you progress through the course. The following matrix is designed to help you develop that knowledge and assist you in understanding how health care is financed and how health insurance influences patients and providers as important foundational information for your role as a future health care worker. Fill in the following matrix. Each box must contain responses between 50 and 100 words using complete sentences.…
In the United States, the term managed health care or managed care is applied to express an array of different concepts and techniques aimed at decreasing the cost of providing health services, as well as improving the service quality. Various health organizations and service providers use these techniques. Sometimes they even offer the techniques to other organizations, which are often called Managed Care Organization (MCO). The United States National Library of Medicine defined managed health care program as an initiative or program of reducing unnecessary costs in the health care system by using assortment of mechanisms, which include economic inducements and motivations for the patients and physicians to choose less expensive forms of health care, different programs and techniques for reviewing and improving the medical requirements in specific services, sharing amplified beneficiary rates, controls and monitoring the admissions of the patients and lengths of their staying in the hospitals, the issues of cost sharing as well as reasons for outpatient surgery. The health care programs and strategies may be provided in different settings within different systems, like Preferred Provider Organizations and Health Maintenance Organizations.…
Understanding health care financial terms is a prerequisite for both academic and professional success. This assignment is intended to ensure you understand some of the basic terms used in this course.…
From these chapter I have gain the knowledge of know, the delivery of health traditionally evolved around the individual relationship between the provider and patient/consumer. The payment was either provided by a health insurance company or paid out of pocket by the consumer. This fee-for-service system or indemnity plan increased the cost of healthcare because there were no controls on how much to charge for the providers service. As healthcare costs continued to spiral out of control throughout the decades, more experiments with contract practice and prepaid service occurred randomly across the U.S. healthcare system (Shi & Singh, 2008)…
For the past several years, the health care and insurance industries in America have been undergoing significant reform in order to rein in the high cost of delivering health care services. Managed care has become a cornerstone of this process (Strickland, 1995). The case management industry (with its focus on cost containment, managed competition, and quality care) is playing an increasingly important role in the managed care environment (Owens, 1996). According to Mullahy (1995a), the number of case managers has risen astronomically in recent years. These individuals come from diverse professional backgrounds and practice settings that include nursing, rehabilitation counseling, and social work.…
The three primary steps to establishing financial responsibility for insured patients are verifying the patient’s eligibility for indemnity benefits, determining pre-authorize and referral requirement, and determining the main payer if more than one indemnity plan is within effect. There are three factors that ascertain patient benefits eligibility. These factors are coverage might cease on the concluding day if the month within which the employees active full-time service is concluded, such as terminus, furlough, or disablement. The employee might no longer measure up as a member of the group. For exemplar, roughly companies do not furnish benefits for part-time employees. If a full-time employee alters to part-time employment, the coverage ceases. An eligible dependent’s coverage might cease on the concluding day of the month within which the dependent status ceases, such as making the age boundary stated within the policy (p. 90). Whenever an insured patient’s policy does not cover a planned service, such situation is talked about with the patient. Patient’s are to be informed that the payer does not pay for the service and that they are creditworthy for the charges. Some payers expect the doctor to use particular forms to tell the patient regarding uncovered services. These financial agreement forms, which patients must pre-indications demonstrate that patients have been told about their responsibility to devote the bill before the services are applied. For exemplar, the Medicare plan furnishes a form, called (ABN) - advance beneficiary notice that must be used to demonstrate patients the billings. The contracted form, allots the practice to compile defrayment for a furnished service or append directly from the patient if Medicare declines reimbursement (p.…
The health care industry is a multi-million dollar industry. Health insurance, providers, technology management, and inpatient and outpatient procedures are among the many terms that we hear nowadays within this industry. The principal phrase that seems to be ringing in the ears of the government and policymakers are debt and cost-control. There are fundamental concepts that should be understood throughout the health care industry as it relates to finance. On one hand, many individuals have a general knowledge concerning health care organizations from the standpoint of insurance, copays, and deductibles. These constructs are more familiar to a person that has any health care needs due to the routine of having to provide some form of payment…
Managed care has been formed since the 1930 and evolved over the last ten years. Since the evolving of managed care there are three types of managed care plans. People that are enrolled in private health insurance are subscribed to a type of managed care plan. There are many differences between the three types of managed care plans and they also have similarities. The involvement of managed care plans are between the insurer and the selected network of health care providers, and the policyholder’s financial incentive that are used by the providers in the network. There are precise measures for choosing a managed care plan and conventional procedures to acquire quality care (Types of Insurance, 2010).…
With the enactment of the Patient Protection and Affordable Care Act (PPACA) in March 2010, health care reform has become the law. The legislation will extend health care coverage to more citizens, stabilize health insurance markets, enhance regulation and consumer protection, and improve the affordability and quality of health care in the United States. Changes in payment system of health care proposed by PPACA have led to the development of Accountable Care Organization (ACO). This paper will address how ACOs and the bundled payments system will impact the future of health care.…
Managed care is a type of system that was formed to help control the costs and quality to health care services; this will give access to services to specific groups of covered patients. The system was created to help the patients (customers) to receive services without having the full financial burden (University of Washington, 1998). The managed care services’ goal is to be able to help individuals and their families by providing health care services that is affordable. This type of managed care will help employees or individuals by requiring a set fee to be paid to the physician for visits, a co-pay and monthly premium to be paid to the insurance company. This will lower the amount that the patient has to pay. There have been many demands that have been needed in the managed care system; changes have had to be made to keep improving the health care services to help it to continue to grow. This paper will cover how the managed care began, in addition to how the system has grown and the changes of the system.…
This paper is an overview of the Medicare system and how it works. The document is intended…
Very helpful post about different types of contract that are used in healthcare field. Work in the health care field, but never noticed that those kinds of contract are also done. Those term in your post are really helpful because it helps to understand the different kind of contract with their purpose. Contract is the legal agreement between two parties and it help to reduce the violation. Different types of contrast are used in healthcare field for legally binding of both patients and hospitals. The term and condition of the contract may be varies depending upon purpose and agreement and normally either express or implied (Laws, 2017). Express contracts done between the healthcare provider and patient are enumerated, and date specific. Implied…